Trinidad

MISSION-CHIROPRACTIC TRINIDAD

TRINIDAD MISSION TRIP

ChiroMission Trip to Trinidad!!! Mark your calendar. September 30 to October 4, 2009. There will be
three meals a day,there will be accommodations for all chiromissionaries; there will be
transportation to all sites throughout the country. There will be thousands of patients
who need your love and miracle hands. We have at least 15,000 people in Trinidad to
adjust. We will be in serving in several Trinidad cities.

Wednesday, September 30th, 2009 (Welcome to Trinidad) Arrive at Airport in Port of Spain,
Trinidad proceed through customs and be picked up by staff. You will be driven to our
accommodations where you will have a nice and relaxing typical Trinidad day.  Welcome
dinner and philosophy to follow.

Thursday and Friday October 1st - 4th, 2009 - (Full Day Mission). Serving and adjusting
as we intend to help over 15,000 on this trip.  Begin the day with introduction
adjusting session at a prayer house. We will see people for 4-5 hours and then break
for lunch. In the afternoon we will be at schools, orphanages and churches.

Friday October 2nd, 2009 - (Full Day Mission). Begin the day with introduction adjusting
session at a prayer house. We will see people for 4-5 hours and then break for lunch. In
the afternoon we will be at schools, orphanages and churches.

Saturday, October 3rd, 2009 (Full Day Mission) Armed with love and generosity you will
meet, care for and set free both yourself and the warm, wonderful people of the area.
All DC's will break up into teams and go to various locations including churches, and
orphanages. At all times you will be accompanied by Chiromission team members.

YOU WILL BREAK THROUGH TO A NEW YOU.  Call or write me!! Peter Morgan, DC for more
information.  646-323-9254 

MISSION-CHIROPRACTIC

APPLICATION FOR MISSIONARY SERVICE

The information received through this questionnaire will be held in confidence and reviewed by the Mission Chiropractic Board. Additional information is requested on the application for emergency references.

Please return this application to: Fax: 914-381-3199 or Email: Chirorye@aol.com

Trinidad Mission Trip ¨C Wednesday September 30, 2009 starts at 6 PM - Sunday October 4, 2009

Name: ___________________________          ¡õ Male   ¡õ Female:

¡õ          Doctor of Chiropractic                     ¡õ          Spouse                      ¡õ          Volunteer

¡õ          Chiropractic Assistant                     ¡õ          Student

Office Address: _______________________________________________

City: ____________________      State: ________          Zip Code: __________

Work Ph: (____)-______________                      Fax #:  (____)-_____________

E-Mail:  ________________________________

Residence Address:

City: State: Zip Code:

City: ____________________      State: ________          Zip Code: __________

Home Ph: (____)-______________         Passport #: ____________________

Date of Birth: __________________      

*IN CASE OF EMERGENCY NOTIFY:

Name: ________________________________ / Relationship: _________________

Address: ________________________________

Ph: (____)-__________________

*FAMILY:

Marital Status: ___________________   Spouse's Name: _______________________

Number of Children: __________  

EDUCATION:

Chiropractic College Year of Graduation: ____________________________________

Disclaimer:  Mission-Chiropractic is an organization that only wishes to provide the opportunity for all DC¡¯s to partake in a life changing experience for the benefit of the DC and those you help on the Mission. During your trip you will be in a third world country and you will voluntarily partake in physical activities such as walking, climbing, swimming, and adjusting. By signing the line below, you agree that anything that happens to you while on this mission is on your own accord and will not hold Mission Chiropractic liable for any injuries or misfortune.

X Signature:  ­____________________________________   Date:  ____________________

FEES

Fees include three meals a day, accommodations for all chiromissionaries; and transportation to all sites throughout the country:

Full Name:  _______________________________ License #: ____________ State: _________

Payment: ¡õ VISA                 ¡õ MC  ¡õ American Express

Credit Card #: ______________________________________                   Exp Date:  _____/_____

Enter Four Digits for Amex Card: __________

Please Check one:  Total $999 (before September 1,  2009, $1099 after September 1, 2009) ¡õ $1199 (after September 15^th, 2009)  Students: $899

                                        YOU ARE RESPONSIBLE FOR AIRFARE.
     

X Signature:  _______________________

For more information email Dr. Morgan at:chirorye@aol.com